Nitrous Oxide: Treatment and rehabilitation

Last modified: Saturday, 20. June 2009 - 2:17 pm

In 1999, 7.8 million Americans reported the illicit use of nitrous oxide at least once in the prior 12 months. Yet according to SAMHSA, substance abuse treatment admissions for all inhalants accounted for only slightly over 1,300 of the almost 1.6 million substance abuse treatment admissions that same year. Inhalant treatment numbers are low because inhalants are accessible and legal. They are easy to hide, use, and abuse in secrecy. And because they are legal, users often don’t consider them a “real drug.” Adults sometimes consider inhalant use a phase that adolescents will “grow out of in time. Interestingly enough, the majority of inhalant users who reported illicit use of nitrous oxide are 18 and older — with most of them over the age of 25 (according to data in the “National Household Survey on Drug Abuse 2000”). Specialized treatment programs targeted at inhalant abusers are still rare in the United States, although many general drug treatment programs can and do successfully treat these patients. Unfortunately, inhalant abusers suffer a higher rate of “relapse” (a return to drug use) than abusers of other drugs, in part because legal inhalants are widely available in just about any store. As of early 2002, there were only a handful of specialized inhalant abuse treatment centers in the United States, including programs in Texas, Wisconsin, South Dakota, and New Mexico. Several treatment programs in the United States have been designed for healthcare professionals with substance abuse problems. Facilities like the Talbott Recovery Center in Atlanta, Georgia have customized rehab programs for physicians, pharmacists, dentists, and nurses. These programs focus on long-term recovery, as well as on returning the patient to their healthcare career or a suitable alternative. Drug rehabilitation programs may be either “inpatient” or “outpatient.” Inpatient, or residential, drug programs require a patient to live at the hospital or rehab facility for a period of several weeks to several months. Outpatient programs allow patients to spend part of their day at the treatment facility, and return home at night. Nitrous oxide is rapidly eliminated from the body, and abuse of N20 alone is not associated with withdrawal. This means that a lengthy detoxification period (removal of the drug from the body) is typically not required. However, if the patient has also been abusing other inhalants, the detoxification period could conceivably take up to 40 days, depending on the chemicals involved. Withdrawal symptoms in inhalant abusers may include nausea, vomiting, muscle pain and cramping, chills and sweats, irritability, tremors, headaches, and hallucinations. Depending on the severity of the symptoms and the patient’s physical condition, the controlled environment of a residential setting may be preferred for the detox period. After detox, the primary goals of treatment are abstinence (i.e., quitting the drug) and long-term recovery. Recovery is the life-long process of avoiding not just drug use, but the unhealthy behaviors and thought patterns that trigger it as well. An effective drug rehabilitation program focuses on changing these patterns of behavior and teaching recovering patients coping skills. Drug education on the long-term physical and Mental effects of substance abuse is also part of a rehab program. “Relapse” — using a drug again after a period of sobriety or abstinence — may occur if the emotional and behavioral issues surrounding drug use aren’t understood. Some of the methods used to understand them include individual psychotherapy, behavioral therapy, cognitive-behavioral therapy, group therapy, and family counseling.Individual psychotherapy One-on-one counseling that explores the emotional issues underlying a patient’s drug dependence and abuse. Individual psychotherapy is particularly when there is also some type of mental disorder, such as depression or an anxiety disorder along with the drug abuse.Behavioral therapy Behavioral therapy focuses on replacing unhealthy behaviors with healthier ones. It uses tools such as rewards (positive reinforcement for healthy behavior) and rehearsal (practicing the new behavior) to achieve a drug-free life.Cognitive-behavioral therapy Like behavioral therapy, cognitive-behavioral therapy (CBT) also tries teaching new behavioral patterns. However, the primary difference is CBT assumes that thinking is behind behavior and emotions. Therefore, CBT also focuses on — and tries to change — the thoughts that led to the drug abuse.Family therapy Family members often develop habits and ways of coping (called “enabling”) that unintentionally help the addict continue their substance abuse. Group counseling sessions with a licensed counselor or therapist can help family members build healthy relationships and relearn old behaviors. This is particularly important for adolescents in drug treatment, who should be able to rely on the support of family.Group therapy Group therapy offers recovering drug abusers a safe and comfortable place to work out problems with peers and a group leader (typically a therapist or counselor). It also provides drug abusers insight into their thoughts and behaviors through the eyes and experiences of others. Substance abusers who have difficulty building healthy relationships can benefit from the interactions in group therapy. Offering suggestions and emotional support to other members of the group can help improve their self-esteem and social skills.Self-help and twelve-step groups Self-help organizations offer recovering drug abusers and addicts important support groups to replace their former drug-using social circle. They also help create an important sense of identity and belonging to a new, recovery-focused group. Twelve-step groups, one of the most popular types of self-help organizations, have been active in the United States since the founding of Alcoholics Anonymous (AA) in 1935. Narcotics Anonymous (NA), a group that serves recovering drug addicts, was founded in 1953. Like AA and other 12-step programs, NA is based on the spiritual philosophy that turning one’s will and life over to “a higher power” (i.e., God, another spiritual entity, or the group itself) for guidance and self-evaluation is the key to lasting recovery. The accessibility of self-help groups is one of their most attractive features. No dues or fees are required for AA and NA, so they are a good option for the uninsured and underinsured. Meetings are held in public places like local hospitals, healthcare centers, churches, and other community organizations, and frequent and regular attendance is encouraged. In addition, 12-step groups work to empower members and promote self-esteem and self-reliance. NA meetings are not run by a counselor or therapist, but by the group or a member of the group. The organization encourages sponsorship (mentoring another member), speaking at meetings, and other positive peer-to-peer interactions that can help reinforce healthy social behaviors. Today, the internet and on-line support communities have added a further degree of accessibility to those who live in rural or remote areas.